Private Alternatives Research Articles

Secure Implementation in Queueing Problems

This paper studies secure implementability (T. Saijo, T. Sjostrom and T. Yamato, “Secure Implementation,” Theoretical Economics, Vol. 2, No. 3, 2007, pp. 203-229) in queueing problems. Our main result shows that the social choice function satisfies strategy-proofness and strong non-bossiness (Z. Ritz, “Restricted Domains, Arrow-Social Welfare Functions and Noncorruptible and Non-Manipulable Social Choice Correspondences: The Case of Private Alternatives,” Mathematical Social Science, Vol. 4, No. 2, 1983, pp. 155-179), both of which are necessary for secure imple- mentation, if and only if it is constant on the domains that satisfy weak indifference introduced in this paper. Weak in- difference is weaker than minimal richness (Y. Fujinaka and T. Wakayama, “Secure Implementation in Economies with Indivisible Objects and Money,” Economics Letters, Vol. 100, No. 1, 2008, pp. 91-95). Our main result illustrates that secure implementation is too difficult in queueing problems since many reasonable domains satisfy weak indifference, for example, convex domains.

Effect of corruption on medical care in low‐income countries

Effect of corruption on medical care in low‐income countries

The DR-CAFTA and the Costa Rican Health Sector: A Push Toward Privatization?

THE DR-CAFTA AND THE COSTA RICAN HEALTH SECTOR: A PUSH TOWARD PRIVATIZATION? Mary A. Clark Tulane University Introduction Since Latin American countries began to adopt outward-oriented economic reforms three decades ago, there has been concern about what exposure to international markets might mean for core welfare state functions, such as social insurance programs. Costa Rica’s welfare state has been a shining example of meaningful public social protection policies, most notably in health care. But in 2009, eighty-five years of public monopoly over insurance, including health insurance, ended when the DR-CAFTA (Dominican Republic-Central America Free Trade Agreement) entered into force in Costa Rica. The question of whether the country should adopt the trade agreement had ignited social protest and forced a national referendum in 2007, narrowly won by the yes vote.1 One issue central to the conflict had been what the DR-CAFTA would mean for the state’s future role in social service provision, such as healthcare. The national health system is the crown jewel of Costa Rica’s welfare state and, more widely, a success story among middle-income countries for its near-universal reach and low per-capita cost. Will Costa Rica’s ascension to the DR-CAFTA commence a rolling back of public health insurance and medical services in favor of greater private-sector participation? Not in the short term. While the DR-CAFTA forced Costa Rica to allow the sale of private insurance policies, it did not change the constitutional requirement that channels all obligatory social security payments to the Costa Rican Social Security Institute (Caja Costarricense de Seguro Social or CCSS). And there is currently no active political campaign to privatize the institution or its health insurance functions. In addition, the nascent private health insurance market is developing slowly. Over the longer term, however, the legalization of private health insurance could abet an emerging trend toward passive privatization. The private medical sector is growing and Costa Rican citizens are making more use of it. As long as Costa Ricans are obligated to make health insurance payments to the CCSS, the performance of this institution will largely govern the attractiveness of private alternatives. The Potential Impact of the DR-CAFTA on Costa Rica’s Health Sector Costa Rica’s inexperience with private insurance fuels concern about what the opening of the health insurance monopoly, particularly to The author would like to thank CIPR for support of a research trip to Costa Rica in June, 2010. C 2011 Southeastern Council on Latin American Studies and Wiley Periodicals, Inc. 3 The Latin Americanist, September 2011 international corporations, might mean for the local market. Firms headquartered in other DR-CAFTA signatory countries, including the United States, can compete on an equal footing.2 A search of extant literature yields limited information about the impact of foreign penetration on Latin American health insurance markets. The research we do have emphasizes the negative impact of such investment. Celia Iriart, Elías Merhy, and Howard Waitzkin (2001) report that U.S.-based multinational health insurance corporations have entered Latin American markets by purchasing established local companies, investing in joint ventures, and entering into contracts to manage public social security funds. Although they focus on causes rather than effects, the main result they discuss is a negative one: increased administrative costs (p. 1249). Rebeca Jasso-Aguilar, Howard Waitzkin, and Angela Landwehr (2004) focus on the impact of multinational investment in Latin American health insurance markets. They discuss a number of effects, all of them fairly negative. These include the footloose nature of foreign investment in health insurance markets, cream skimming, problems often associated with managed care (restrictive utilization review, increased cost sharing for patients, declines in spending on clinical services versus administrative costs), and concurrent reductions in government spending on public health services. Denis Drechsler and Johannes Jutting (2007) concur, arguing that private health insurance in Latin America (based on multinational or local capital) has resulted in predatory competition. Instead of dropping in price, premiums have remained high and only accessible to upper-income groups. Unfortunately, these studies do not shed much light on what we ought to expect in Costa Rica. They overlap in their...

Environmental Regulation and Trade Openness in the Presence of Private Mitigation

Acknowledging the differential ability of individuals to privately mitigate the consequences of pollution is essential for an understanding of demands for regulation of the environment and of trade in dirty goods, and for analysis of the implications of these demands for equilibrium policy choices. In a small open economy with exogenous policy, we first explain how private mitigation results in an unequal distribution of the health consequences of pollution in a manner consistent with epidemiologic studies, and consequently how the benefits and costs of trade in dirty goods interact with choices concerning private mitigation to polarize the interests of citizens concerning environmental stringency. The economy is then embedded in a broader political economy setting, and simulated to investigate the role of private mitigation in the determination of policy choices. We show that when citizens can effectively choose between costly collective and costly private alternatives for pollution control, the same polarization of interests underlies equilibrium policy choices concerning environmental regulation and trade openness in democratic and autocratic regimes.

The Paradox of State Retrenchment in Sub-Saharan Africa: The Micro-Level Experience of Public Social Service Provision

Summary Over the past 30 years in Africa, neoliberal economic reform has meant a major retrenchment of the state provision of health and education with paradoxical local effects. Based on an analysis of 2005 Afrobarometer data, the study finds that the rural poor are more likely to use public schools and clinics than the urban, better-off. The data suggest that a two-tiered social service system now exists across many African countries where the rural poor may have little choice but to use public social services while the urban, better-off choose to pay for private alternatives. The author argues that concerns about ensuring absolute levels of access have obscured attention to the micro-experience and quality of social service delivery.

The Emergence of Organized Criminal Networks as Extralegal Authorities

Globalization and the contemporary global order have facilitated the emergence of new aspects of governance within, between, and across the state scale. The re-articulation and re-scaling of the state involves the devolution of specifi c aspects of governance capacities to supraand sub-state scales, constituting a vast transglobal arena where a bewildering array of private, non-state actors, networks and polities take on roles previously performed by the state. This reconfi guration of the position of the nation-state transcends the Westphalian “territorial trap,” when it comes to produce new sites of power, new forms of authority and regulation through a reshuffl ing of traditional sociopolitical relationships. The distinguishing feature of these alternative authority structures is that they tend not to be embodied at what has been historically constituted as the national or local scale, but rather are represented along the multiple, overlapping scales that make up global relations. Within those hybrid scales a broad spectrum of actors interact and struggle for power and control: from public and private alternatives to sovereign states, from institutions of global governance to the transnational third sector, from religious movements to complex criminal organizations. Among the most signifi cant developments that has taken within this arena and has been fostered by the attendant sociopolitical and economic changes is the emergence and empowering of criminal organizations, whose cross-border networks and ability to continue their activities depends on their capacity to delegitimize governmental efforts to control their behavior. Complicating matters further, the strengthening of regulatory regimes usually creates perverse incentives for organized crime groups to expand their activities and increase their profi ts. Throughout the 1980s and 1990s, it became increasingly clear that the rise of transnational organized crime was inextricably connected with contemporary changes in the scope and competence of states’ authority over their societies and territory,

Is the Canadian System Right for the United States?

While political realities make it quite unlikely the United States will move to a single-payer system, there may nevertheless be lessons to be drawn from Canada’s experience as well as from the experience of other nations. Canadian Medicare is presented as both a savior and a foe to American patients. On the one hand, it is a symbol to progressive American scholars of accessible health care without the command-and-control features of, for example, the UK system. On the other, its effective bans on supplementary PHI for queue jumping and top-ups leave too little room for embedded private insurance companies. The most likely model would see a significant role for private health insurance in providing the core plan to which there is universal access.This paper argues that whatever the path forward for the United States, there will be a need to attend to the interplay between private health insurance (supplementary and complementary) and the established “basic” or core plan — whether single payer, social health insurance, regulated universal private health insurance, or some variant thereof — with a view to balancing access, equity, and cost. If the basic or core plan is bare bones, the role for complementary/ supplementary private insurance will be proportionately large, particularly if co-payments are high. If rationing is too severe within the core or basic plan, this will generate demand for private alternatives to avoid queues. If private insurers are harnessed to provide the core or basic plan and are also allowed to tie this product to offerings of supplemental or complementary private health insurance, then regulation will likely be required to ensure that the tied products are not used to effectively circumvent requirements that private insurers not select on risk in the basic or core plan. The dynamics within a particular system are very context specific, which, it must be conceded, limits our ability to reliably transplant lessons from one country to another Hence, the enormous challenge facing U.S. lawmakers as they attempt to design and implement foundational changes.

Reactions to Comments on Great Britain

Back to table of contents Previous article Next article Letters to the EditorFull AccessReactions to Comments on Great BritainJoseph Berger, M.D.Joseph BergerSearch for more papers by this author, M.D.Published Online:7 Nov 2008https://doi.org/10.1176/pn.43.21.0024In the August 15 issue, APA President Nada Stotland, M.D., concluded her column by describing her visit to the Royal College of Psychiatrists' annual conference with the comment, “While there is some interest in privatization, most people are satisfied with the current system,” and she noted that “over the past 10 years, the NHS [National Health Service] has greatly reduced waiting times and introduced standards... and is moving in the direction of increased patient choice.”These comments combine a quite remarkable and very unfortunate distortion of the true situation with a failure to understand and realize why the positive elements are almost entirely a product of the element that Dr. Stotland chose to minimize.The real situation is that there is a very large private health care system in Great Britain, with leading private hospitals, clinics, and physicians providing care to large numbers of people who pay for that care through insurance offered by a few private companies. The enormous growth in the private alternative dates from the time when Margaret Thatcher was prime minister.It is the presence of this private alternative that has provoked the NHS to make whatever small improvements it has made in the past few years. It is a response to public demands and the comparisons that citizens were making between the quality of service and rapid access that the private alternatives offered and the huge deficiencies that were notorious and chronic in the NHS.The NHS or public system most definitely offers medical help to anyone. At times the standards may indeed be high, and no sensible voices are suggesting that it be abandoned. But in Great Britain many people know that in the private system they may receive care that they would not receive in the public system, and in the circles of my relatives and friends in Great Britain, all of them have private insurance and at times make crucial and vital use of the private system.Downsview, OntarioDr. Berger is a past president of APA's Ontario District Branch and its representative to the APA Assembly. ISSUES NewArchived

Public and private environmental spending: a political economy approach

This study examines the level of public investment in environmental quality when there are private alternatives. Public investment is chosen by majority voting. When consumption and environmental quality are complementary, one may observe a solution of the type “ends against the middle.” The setting is intertemporal. Parents are altruistic and they can express their altruism by leaving financial bequests, but also by voting and contributing to the environmental quality their children will enjoy.

Putting a Band-Aid on a Corpse: Incentives for Nurses in the Indian Public Health Care System

The public Indian health care system is plagued by high staff absence, low effort by providers, and limited use by potential beneficiaries who prefer private alternatives. This artice reports the results of an experiment carried out with a district administration and a nongovernmental organization (NGO). The presence of government nurses in government public health facilities (subcenters and aid-posts) was recorded by the NGO, and the government took steps to punish the worst delinquents. Initially, the monitoring system was extremely effective. This shows that nurses are responsive to financial incentives. But after a few months, the local health administration appears to have undermined the scheme from the inside by letting the nurses claim an increasing number of "exempt days." Eighteen months after its inception, the program had become completely ineffective.

Competing Environmental Management Standards: How ISO 14001 Outnumbered EMAS in Germany, the UK, France, and Sweden

In the middle of the 1990s two international environmental management standards became available for European companies: the European Eco-Management and Audit Scheme (EMAS) and the International Organization for Standardization's ISO 14001. Companies that wanted to implement a standardized environmental management system were confronted with the choice between their national standard, the European standard, or the international one. In the past decennium, the national standards have been abolished and the number of ISO 14001 certified companies has outnumbered the number of EMAS-registered organizations. The speed at which and the extent to which ISO 14001 has outnumbered EMAS differs, however, between countries in the EU-15. We argue that a country classification based on the degree of statism of the collective agency on the one hand, and the degree of corporatism of society's organization on the other, offers a valuable perspective for analyzing the evolution of the uptake of both standards in a country. We present the cases of Germany, the UK, France, and Sweden, and conclude that in countries characterized by a more societal organization of authority, private alternatives for national regulations like ISO 14001 are welcomed and adopted with enthusiasm. In countries characterized by a rather statist organization, such alternatives are looked upon with more suspicion resulting in delayed uptake. Whereas ISO 14001 is a purely private initiative, voluntary registration to the EMAS regulation creates a link between the company and the authorities. In contrast to corporatist settings, this frightens off business participation in associational countries.

Notions of just health care at three Swedish hospitals

This article investigates what notions of "just health care" are found at three Swedish hospitals among health care personnel and whether these notions are relevant to what priorities are actually made. Fieldwork at all three hospitals and 114 in-depth interviews were conducted. Data have been subject to conceptual and ethical analysis and categorisation. According to our findings, justice is an important idea to health care personnel at the studied hospitals. Two main notions of just health care were found. The main idea was the notion of "equal treatment according to need", the basic idea being that differences in treatment should be justified by differences in needs. The competing idea that merit should affect the treatment received is occasionally encountered, the idea here being that patients, by acting irresponsibly, may no longer deserve to be treated strictly according to needs. In practice, priorities are made on grounds that only partly comply with the basic idea of justice in health care, as it is understood by staff at the studied hospitals. Exceptions are made due to regional differences, considerations of cost-effectiveness, economic incentives, tradition, the daily patient flow, research, private alternatives, patient influence and favouritism of health care personnel.

Central versus local education finance: a political economy approach

This paper models voters’ preferences over central versus local education policies when there are private alternatives. Education is financed by income taxes and individuals are mobile between communities. Public education levels are chosen by majority vote. Contrary to conventional wisdom, centralisation may benefit the rich and poor, while the middle class prefer decentralised education. The model is also extended to include peer effects. Peer effects increase the support for central school finance, even in the community with good public schools.

Why Some People Go Private and Others Do Not: Supplementary Health Insurance in Spain

Although the National Health System (NHS) is the main healthcare financing body in Spain, an increasing share of the population ‘goes private’ by obtaining supplementary private healthcare insurance (PHI). Qualitative research is very limited and empirical studies hardly ever provide us with what lies behind the figures. This paper seeks to examine qualitative and quantitative evidence on the individual's motives for the purchase of PHI. We undertook two focus groups together with a representative survey containing open–ended and closed questions among a sample of the Catalan population. Our findings indicate a high degree of heterogeneity in the motives for going private, ranging from the already acknowledged ‘quality motive’ to simple tradition. A certain share of the population reveals ‘captivity’ and satisfaction towards the NHS, as well as being unable to afford private alternatives. Furthermore, risk aversion and income was significantly higher for those purchasing PHI.

The Politics of Race and Public Space

Focusing on the city of Atlanta in the late 1950s and early 1960s, this article examines the ways in which the desegregation of public spaces, such as golf courses, buses, and parks, helped crystallize two central elements of suburban conservatism—privatization and the “tax revolt.” As such spaces desegregated, white Atlantans fled from them and created private alternatives instead. As they did, they also fought to take their finances with them, staging an early, though often overlooked, tax revolt, rebelling against the use of their taxes to support municipal spaces and services they no longer used. As this article demonstrates, white flight was not merely a physical retreat of whites from the city to the suburbs. Their withdrawal first unfolded in a less literal sense, as they withdrew their support—political, social, and financial—from a city and a society that they believed had already abandoned them.

El Problema de la Vivienda en el Perú, Retos y Perspectivas

In Peru, the need to improve housing quality, the so called qualitative deficit, is a substantial problem to housing and it affects 74 per cent of the population. That means that in most cases the houses do already exist but their inhabiting conditions are inadequate. This paper analyses to what extent housing policies face this problem. It is interesting to know the current programs and projects, their characteristics and financial conditions among other factors, as well as the housing, services and equipment strategies. Private alternatives and their feasibility to face this problem are also analysed.

How the Law Responds to Self-Help

Legal rules are typically implemented through a combination of public and private mechanisms. Burglars, for example, are deterred from unauthorized entry in part by the threat of jail time and police intervention, and in part by the knowledge that homeowners have guns, security systems, and other private measures by which to defend their property. Similarly, while entrepreneurs obviously use patent, copyright, and trade secret law to protect proprietary information, they also routinely take matters into their own hands by, for example, dividing sensitive information across employees such that no single employee ever knows enough to betray the firm completely. Every area of law can to some degree be characterized in this manner, framed in a way that emphasizes substitutability between public responses and their private alternatives. In this Essay, I examine several specific areas of law (free speech jurisprudence, trade secret law, copyright law, and patent law) from this perspective, using each as a case study from which to cull broader lessons about the proper structure for these public/private partnerships.

Payment and Financial Innovation, Reserve Demand and Implementation of Monetary Policy

The consequences of electronic trading, payment and settlement have recently become one of the main topics in monetary economics. New innovations in payment and settlement technology are challenging the central bank's monopoly over the supply of base money, which is generally considered the cornerstone of the central bank's power to set the short-term interest rate for the economy. This paper demonstrates that the development of the economy's transaction technology over time has indeed had a significant quantitative impact on the demand for currency and bank reserves, and indirectly on the modalities of the supply of reserves by the central bank. In contrast to past trends, the latest innovations in payment and settlement technology imply not only a quantitative change but also a qualitative one, as they enable private institutions to issue settlement money that competes with the liabilities of the central bank. The paper presents a model on the implementation of monetary policy in an economy where such private substitutes for central bank money are available for the settlement of transactions, showing that effective monetary control by the central bank might indeed be compromised in those circumstances. However, the study also highlights several attributes that may distinguish central bank liabilities from any private alternatives, some of which are based on the central bank's traditional role as the banker for the Government.

An Experimental Investigation of Excludable Public Goods

This paper extends the research on incentive compatible institutions for the provision of public goods by imposing a minimum contribution that must be met in order for an individual to enjoy the benefits of the public good. Excluding individuals who do not contribute at least the minimum transforms the linear n-player pure public goods game to an n-player coordination game with multiple, Pareto-ranked Nash equilibria. The experimental results show that exclusion increases contributions to the public good in most cases. However, an increase in contributions may not be sufficient to increase social welfare because there is a welfare cost to excluding individuals when the good is non-rival. Furthermore, exclusion can decrease both contributions and welfare in environments in which individuals fail to coordinate their contributions. The results are sensitive to the minimum contribution requirement and to the relative returns from the public and private alternatives.

URBAN FORTRESSES

One of the consequences of the state's inability to protect the life and property of all its citizens—especially in developing countries—is the formation of private alternatives to crime prevention and control. Gated communities, or enclosed neighbourhoods, are one such popular alternative. This article compares the phenomenon of gated communities in two developing countries: South Africa and Brazil. Both countries are plagued by violent crime and share key human development indicators. The article also explores key issues that have been raised around gated communities in both countries. Gated communities can contribute to spatial fragmentation in urban areas, and reflect increased polarisation, fragmentation and diminished solidarity within society. By excluding other urban residents and people from surrounding neighbourhoods, gated communities can contribute to social exclusion, inhibiting the construction of social networks that form the basis of social and economic activities.